PHARMACY TECHNICIAN APPLICATION …

1 California State Board of PHARMACY BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY. 1625 N. Market Blvd, N219, Sacramento, CA 95834 DEPARTMENT OF CONSUMER AFFAIRS. Phone: (916) 574-7900 GOVERNOR EDMUND G. BROWN JR. Fax: (916) 574-8618. PHARMACY TECHNICIAN APPLICATION INSTRUCTIONS. HOW LONG WILL IT TAKE TO PROCESS MY APPLICATION ? Allow the board 45 days to process your APPLICATION . The board will notify you by mail if your APPLICATION is not complete. Please do not contact the board to check on your APPLICATION unless it has been on file for over 60. days. If your check has cleared your bank, the board has received your APPLICATION . To check if your license was issued, go to Select Verify a License and enter your name. It takes four to six weeks from the date a license is issued to receive the physical license in the mail. WHAT MAKES AN APPLICATION COMPLETE? Check the boxes below to be sure your APPLICATION is complete before mailing it to the board. If your APPLICATION is not complete, you will receive a Deficiency Letter in the mail.

2 You will then have 60 days to submit the required item(s). If you do not submit the required item(s) within 60 days, you may have to file a new APPLICATION with new fees and meet any new requirements. APPLICATION FEE $140: When you send your APPLICATION , include a check or money order for $140 made payable to the Board of PHARMACY . The APPLICATION fee is non-refundable. APPLICATION FOR A PHARMACY TECHNICIAN LICENSE (form 17A-5 (rev. 10/2015): Complete the entire APPLICATION . AVOID COMMON MISTAKES. The name on each form must be EXACTLY THE SAME as the name on your state driver's license or state-issued identification card. Your name must be the same on each of the following documents: PHARMACY TECHNICIAN APPLICATION , Request for Live Scan form or fingerprint cards, and Self-Query Report. Have you ever used a different name? List each prior name on the APPLICATION under Previous Names. Did you have a maiden name, married name, former name, AKA? Have you ever used Jr., Sr.)

3 , II, etc., with your name? If you do not list all of your previous names, the board may not locate, match or verify your documents. Do not leave anything blank; use N/A if a question doesn't apply to you. Do not let your school fill out Pages 1, 2 and 3 of your APPLICATION . You must sign and date the APPLICATION . No one else can sign it for you. Signatures must be original and dated within 60 days of filing the APPLICATION . No electronic signatures will be accepted. Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN): Disclosure of your social security number (SSN) or Individual Taxpayer Identification Number (ITIN) is mandatory and must be included on the APPLICATION and on the Self-Query Report. 1 of 4. 17A-7 (REV 11/2015). PHOTO: Please attach a passport-style photo to page 1 of the APPLICATION (2 x2 glossy color photo) taken within 60 days of filing the APPLICATION . DO NOT provide scanned images, Polaroids, or black-and-white photos. BASIC EDUCATION: You must be a high school graduate or have a general education development certificate equivalent.

4 Attach ONE of the following (A, B, C, D, or E): A. High School Graduate: Attach an official, embossed transcript (academic record) or notarized copy of your high school transcript. It must have the graduation date on it. To get a copy of your high school transcript, contact your high school or its school district office. B. Foreign High School Graduate: Attach a notarized copy of your foreign secondary school diploma or certificate OR a notarized copy of your foreign secondary school transcripts. If not in English, then include a certified translation in English. The translation may be from an evaluation service that states your education is equal to graduating high school in the C. High School Equivalency: (Attach 1, 2, or 3 to show documentation of completing one of the three High School Equivalency Tests.). 1. General Educational Development (GED): Attach an official transcript of your test results or equivalent. GED test results are official only if they are earned through an authorized GED Testing Center.

5 To get your GED transcripts, go to If your GED is from another state, you may need to request an official transcript of your GED. test results from the agency in that state. 2. HiSET: Attach an official transcript of your test results or equivalent. HiSET test results are official if they are earned through an authorized HiSET Testing Center. To request your HiSET transcripts, go to 3. TASC: Attach an official transcript of your test results or equivalent. TASC test results are official if they are earned through an authorized TASC Testing Center. To request your TASC transcripts, go to D. Certificate Equivalent Attach an official Certificate of Proficiency showing you passed the California High School Proficiency Examination (CHSPE). To request a copy, go to or call (866) 342-4773. E. Out-of-State High School General Educational Development Certificate Equivalent: Attach an official transcript of your test results or equivalent. PHARMACY TECHNICIAN DOCUMENTS: Attach ONE of the following (A, B, C, or D): A.

6 Affidavit of Completed Coursework or Graduation: The program director, school registrar or pharmacist must complete and sign the affidavit on Page 4. Copies or stamped signatures are not accepted. The school seal must be embossed on the affidavit and/or you must attach a pharmacist's business card with license number. An affidavit is required for one of the following: Associate Degree in PHARMACY Technology;. Any other course that provides a minimum of 240 hours of instruction as required;. Training course accredited by the American Society of Health-System Pharmacists (ASHP);. Graduation from a school of PHARMACY accredited by the Accreditation Council for PHARMACY Education (ACPE). B. PHARMACY TECHNICIAN Certification Board (PTCB) certified: Submit a copy of your PTCB. certificate. 2 of 5. 17A-7 (REV 12/2017). C. National Healthcare Association PHARMACY TECHNICIAN Certification Program (ExCPT): Submit a copy of your ExCPT certificate. Please check the box on the APPLICATION on page 1.

7 Under the PHARMACY TECHNICIAN Qualifying Method Attached is a certified copy of PTCB. certificate program . By checking this box this will identify your APPLICATION as applying under a certification program. D. Military Training: Submit a copy of your DD214 documenting evidence of your PHARMACY TECHNICIAN training provided by a branch of the federal armed services. SELF-QUERY REPORT: Include a sealed, original Self-Query Report from the National Practitioner Data Bank (NPDB). It must be dated within 60 days of filing the APPLICATION . Self-Query Reports that have been opened will not be accepted. The name on your Self-Query Report must be EXACTLY THE SAME as the name on your APPLICATION . You must include your US social security or ITIN number when completing your Self- Query Report. To request a Self-Query Report, go to the NPDB's Web site at or the direct link is NPDB's contact number (800) 767-6732 or TDD (703) 802-9395. Their Web site has a fact sheet and answers to frequently asked questions.

8 The board is not able to assist you with requesting the Self-Query Report. For help, contact the NPDB directly. You must pay the fee directly to NPDB. You must submit a new Self-Query Report even if one was submitted with a previous APPLICATION . FINGERPRINTS: California residents must use Live Scan. Non-residents can visit California to complete a Live Scan or must submit professionally rolled fingerprints on cards supplied by the board. DO NOT complete the Live Scan service or fingerprint cards until you are ready to send your APPLICATION . You must submit a copy of your Live Scan receipt or new fingerprint cards with your APPLICATION . Each APPLICATION requires you to complete a new Live Scan or submit new fingerprint cards. The Live Scan site may charge a processing fee. The board will accept fingerprint responses only from the California Department of Justice (DOJ) and Federal Bureau of Investigation (FBI). Please complete and attach ONE of the following (A or B): A. California Resident: Attach completed Live Scan receipt.

9 The receipt shows you completed the Live Scan. California residents must use Live Scan only. To find a Live Scan location, go to Live Scan operators can make mistakes. You must be sure everything on the form is correct. Make sure the following information is correct when you complete your Live Scan: Type of License/Certification/Permit or Working Title: PHARMACY Tech-Sect 4015. Full Name: Must be EXACTLY THE SAME as the name on your state driver's license or state-issued identification card (Jr., II, etc., must be included). It must also be EXACTLY. THE SAME as the name on your APPLICATION and Self-Query Report. 3 of 5. 17A-7 (REV 12/2017). Date of Birth: Must be correct. Social Security Number: Must be included and be correct, unless you have an ITIN. If you have an ITIN, enter this number in the SSN field. Level of Service: Must include both DOJ and FBI. B. Non-California Resident: You may visit California and complete Live Scan. If you cannot, then you must send two rolled fingerprint cards.

10 You must use fingerprint cards from the Board of PHARMACY . Request fingerprint cards through the board's online services at or email Fee: Include fingerprint card processing fee of $49 ($32 DOJ and $17 FBI), made payable to the Board of PHARMACY . You can send one check or money order for both the APPLICATION processing fee and fingerprint card processing fee. Print legibly or type your personal information on the fingerprint cards. If your personal information is not legible and DOJ enters your information incorrectly, you will be responsible to submit new fingerprint cards and pay the $49 fingerprint card processing fee again. Fingerprints must be taken by a person professionally trained to roll prints. Fingerprint clearances from cards take about six weeks longer than Live Scan. Poor quality prints will be rejected and will cause delay because new fingerprint cards will be required. 4 of 5. 17A-7 (REV 12/2017). California State Board of PHARMACY BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY.